Re: Niaspan vs normal slow release niacin
It should be worth noting that there is no clinical differentiation between the terms "extended", "controlled", or "sustained". Actual dissolution testing of Niaspan, Endur-acin, and Slo-Niacin show they are quite similar, about 5 - 6 hr dissolution times, with niaspan actually being the slowest in this study!
The risk of hepatotoxicity has very little to do with the differences in these ER/SR preparations, rather how much and how often you take them (regimen). THIS POINT IS COMPLETELY OVER-LOOKED IN THE MEDICAL LITERATURE. IR is the safest and is routinely used up to 6 grams (6000mgs) per day. ER/SR preparations first came out without the understanding of the increased exposure to the live, and like IR niacin, were dosed similarly, ie 1000mg three times daily. These are the doses and regimen that are hepatotoxic. Dosing these preparations twice a day can still be very safe at 1000 - 2000mg total daily dose. This is the best tolerated regimen, and improves the LDL reduction at the expense of some HDL increase. Niaspan, contrary to what every physician in the USA has been told, does NOT have a unique dissolution. It did have a unique REGIMEN - once daily ER/SR niacin. This mimics IR niacin - that is, 2000mg all at once produces a high serum peak in the first hour that causes flushing, retains the HDL benefit of IR niacin, and with greater than 12hrs of no niacin exposure to the liver, is associated with very low liver enzyme increases.
One does need to take the choice of niacin seriously. Only products with adequate published data such that the kinetics, safety, and efficacy are known, should be used. Individual response to niacin varies, and physician monitoring of response needs to be done regardless of the preparation you choose for anyone trying to affect changes in their cholesterol.